Proximal Row Carpectomy for Disease of the Proximal Carpal Bone

Rhee, Seung Koo; Kim, Hyoung Min; Kwon, Soon Young; Lee, Hwa Sung; Lee, Hang Kyu

Abstract

The management of pain, stiffness and weakness of the wrist following unsuccessful conservative treatment of fractures of the scaphoid or of Kienbocks disease and so on is a difficult problem. Despite the recommendation by Cotton in 1924 and subsequently by others that the proximal row of carpal bones should be removed in the presence of disease, arthrodesis or various stabilizing procedures continue to be recommended. But, although a radiocarpal fusion, when successful, leads to a painless, stable wrist, the loss of the normal motion of the wrist inevitably results in some loss of function of the hand. The purpose of this study is to evaluate the efficacy of the proximal-row carpectomy. Since 1987, five patients were studied following proximal-row carpectomy. The lesions for which the operation was done included two Kienbocks disease, one crushing injury, one transscaphoid volar lunar dislocation, and one scapholunate dissociation. Their end results after average 74 months of follow-up showed less pain than before operation and a reasonable range of flexion/extension which varied between 65% and 85% of normal, the average being 74%, Postoperative grip strength was from 70 to 90% fo normal, the average being 78%. In conclusion, excision of the proximal row of tile carpus is a useful procedure, with a limited application in patients with Kienbocks disease, dislocation of the lunate bone, scapholunate dissociation and similar injuries which do not respond to conservative management.